Community Investment Fund Grant Accountability Form

Due 31 March 2018

Please complete the following accountability form for your Community Investment Grant. Forms cannot be saved so you will need to complete it in the one sitting.

Please ensure that you have copies of all required supporting documents before completing the form. On submission of your report, you will receive an automated response via email with a copy of your accountability report.

1. Organisation Details

Name of organisation

Name of contact person

Phone number

Email address

2. Funding details

Please provide evidence that explains how your funding was spent. A reminder that Nelson City Council must be specified in your accounts.

Evidence upload (receipts, invoices, or statements)

Photo verification of what was funded

Grant received (ex. GST)

3. Reporting outcomes

Referring to your agreement please list the outcomes you were funded to provide

Will you meet these by 30 June 2018?

Yes

No

If not, why not?

Please summarise what you did and the difference that it made. (200 word limit)

4. Signatory Sign Off

Our organisation has carried out the requirements of the agreement to the best of our ability.

Please tick to confirm*

Full name

Position

Please note that we will be carrying out checks with 10% of funding recipients. This will involve a scheduled meeting with the organisation, with the intention of gaining a better insight into how funding has been spent to achieve outcomes.